FRANKFORT — Therapists who work with abused, neglected and at-risk children told a legislative panel Wednesday that they might have to close their doors if they don't receive back payments from the state soon.

"Our business is struggling to keep the doors open," said Peggy Smith-Puckett, a licensed family and marriage therapist from Glasgow. "We have received only a small fraction of the money we have billed."

Smith-Puckett and other providers in the state's Impact Plus program, which provides therapy to children who are at risk of being removed from their homes, told the Senate Health and Welfare Committee that payments for services provided to 5,700 children in the program have been minimal since the state moved to managed-care Medicaid on Nov. 1.

Impact Plus providers now must bill the four companies that offer Medicaid plans in Kentucky. The managed care companies pay the state, which then pays the providers.

Because of communication mix-ups between the state and the managed care companies, the billing codes for therapy services were not provided to managed care companies in a timely manner, said Sen. Julie Denton, R-Louisville, chairwoman of the Senate Health and Welfare Committee.

That means providers have gone months with only minimal payments. And those payments haven't provided information about which client the state is paying for. Without that information, it's impossible to disburse the money to the appropriate therapists, providers told the committee Wednesday.

Denton said an email from one Impact Plus provider said it had $257,000 in outstanding payments from three managed care companies.

"I want every single Impact Plus provider to be made whole by Monday," Denton said. "This is ridiculous."

Senators said other Medicaid providers — including pharmacists, dentists and doctors — have complained about late payments since managed care was launched in November.

Until the billing snafus are fixed, cabinet officials told the committee, the state is sending therapy providers' payments each week based on billing averages before managed care was launched.

Betsy Dunnigan, deputy commissioner of the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities, said the cabinet also is hosting a workshop next week for the therapy providers and managed care companies to work through their problems.

"These issues were not getting resolved," Dunnigan said.

The therapy providers will have an opportunity to ask questions and have access to the managed care companies' live billing systems, Dunnigan said.

Smith-Puckett said information given to therapy providers during the past few months has been confusing and often contradictory. Meanwhile, therapists are continuing to see children, even if they are not being paid. But it's difficult to say how long that will go on, she said.

Smith-Puckett said she is treating a boy with severe behavioral problems who is violent with his teacher and adoptive parents. During the past year, the boy has shown significant progress, but she recently told the boy's parents she might not be able to continue to provide services.

"Not because I don't want to," said Smith-Puckett, but because she can't continue to work for free.

Denton asked the state to consider paying the providers interest on the money that has not been paid in a timely manner. But Dunnigan said the money comes from Medicaid, a separate department in the Cabinet for Health and Family Services. Any decision to pay interest would have to be made by Medicaid, she said.

Denton said after Wednesday's meeting that she probably would file legislation during this legislative session to require Impact Plus providers to contract directly with managed care companies.

Removing the state as a middleman might simplify the process and speed up payments, she said.

Several lawmakers expressed frustrations with the Cabinet for Health and Family Services during Wednesday's meeting.

Sen. Katie Stine, R-Fort Thomas, said the problems with Impact Plus are indicative of larger problems at the cabinet that include not providing timely information to legislators.

"Let's get an end to this chaos," Stine said.

"It's got to be accountable to the people," Denton said of the cabinet. "We shouldn't have to beg and plead to get answers."

The cabinet will be on the hot seat again Thursday during the House Health and Welfare Committee meeting. Lawyers for the media will testify before the committee about their two-year legal battle to gain access to child-protection records for children who have been killed or nearly killed as a result of abuse and neglect.

Some of the state's family court judges also are scheduled to testify at Thursday's meeting about opening the state's closed juvenile courts to public scrutiny.

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